Telehealth Informed Consent Form Template

What Is a Telehealth Informed Consent?

A telehealth informed consent is a document that specifically addresses the unique considerations, risks, and limitations of providing mental health services through technology rather than in person. It supplements — but does not replace — your general informed consent for treatment.

Telehealth has become a standard modality in mental health practice, but it carries distinct clinical, legal, and ethical considerations that clients must understand before participating. Technology can fail mid-session, privacy cannot be guaranteed in a client's home environment, emergency response is complicated when the client is remote, and licensing laws impose geographic restrictions that do not exist in traditional practice.

The APA Guidelines for the Practice of Telepsychology (2013), the NASW Standards for Technology in Social Work Practice, and virtually every state licensing board now require or strongly recommend that clinicians obtain specific informed consent for telehealth services. Many states have enacted telehealth-specific legislation that mandates particular elements in the consent document. Practicing telehealth without adequate informed consent exposes the clinician to malpractice liability, licensing board complaints, and potential HIPAA violations.

When You Need It

• Before the first telehealth session with any client, whether it is their initial session or a transition from in-person services
• When changing telehealth platforms or technology
• When a client begins accessing telehealth from a new state (licensure verification must occur)
• When your state updates its telehealth regulations and your consent document must be revised
• When adding new telehealth modalities (e.g., adding asynchronous messaging or phone sessions to existing video sessions)
• Annually, as part of a best practice review of all consent documents

Key Components / What to Include

1. Description of Telehealth Services

Define what telehealth means in the context of your practice. Specify the modalities you offer (synchronous video, phone, asynchronous messaging) and clarify that telehealth involves delivering mental health services through electronic communications rather than in-person contact.

2. Technology Requirements and Platform Information

Identify the specific platform you use, confirm that it is HIPAA-compliant and that you have a Business Associate Agreement with the vendor. Describe the client's technology requirements (reliable internet connection, device with camera and microphone, private location). Acknowledge that you cannot guarantee the security of electronic communications despite reasonable safeguards.

3. Privacy and Confidentiality Considerations

Explain that while you will conduct sessions in a private, secure location, you cannot control the client's environment. Advise clients to participate from a private room where they will not be overheard, to use headphones when possible, and to avoid public locations. Address the risk that someone in the client's household may inadvertently see or hear session content.

4. Risks and Limitations of Telehealth

Be specific about risks that differ from in-person treatment. These include: technology failures that may disrupt sessions, reduced ability to observe nonverbal cues, limitations in the clinician's ability to intervene in emergencies, the possibility that telehealth may not be appropriate for all clinical presentations, and the risk that electronic communications could potentially be intercepted despite encryption.

5. Emergency Protocols

This section is critical for telehealth. Obtain the client's physical address at the start of every session (or confirm it has not changed), identify a local emergency contact, and document local emergency resources including 911 and the nearest crisis center. Establish a plan for what will happen if the session is disconnected during a crisis — typically, the clinician will attempt to reconnect, then call the client by phone, then contact the emergency contact if unable to reach the client within a specified timeframe.

6. State Licensure and Geographic Limitations

State that you are licensed in [your state(s)] and that the client must be physically located in a state where you are licensed during the session. Explain that if the client travels out of state, they must notify you before scheduling a session so that you can verify compliance with licensure requirements.

7. Recording Policy

State whether sessions will be recorded and by whom. Most practices prohibit recording by either party. If you do record for clinical purposes, explain how recordings will be stored and protected.

8. Technical Failure Protocol

Describe what happens when technology fails. A standard protocol is: if the session disconnects, the clinician will attempt to reconnect within the same platform; if reconnection fails within five minutes, the clinician will call the client by phone to either resume the session or reschedule.

How to Implement It

Step 1: Verify your state's telehealth requirements. Before drafting your consent, research your state licensing board's specific telehealth regulations. Some states require specific language in the consent document, mandate that you verify the client's identity at each session, or impose restrictions on which services can be delivered via telehealth.

Step 2: Confirm your platform's HIPAA compliance. Ensure that you have a signed Business Associate Agreement with your telehealth platform vendor. Document the platform name, the date of the BAA, and any security features (encryption type, access controls) in your compliance files.

Step 3: Integrate the telehealth consent into your intake workflow. For new clients starting with telehealth, provide the telehealth addendum alongside your general informed consent. For existing clients transitioning from in-person to telehealth, provide the addendum and obtain signatures before the first telehealth session.

Step 4: Collect emergency information proactively. Do not wait for a crisis to realize you do not have the client's physical address or local emergency resources. Complete the emergency protocol section of the consent at intake and update it periodically.

Step 5: Confirm the client's location at each session. Build this into your session opening routine. A simple "Can you confirm your location today?" establishes the record that the client was in your licensed jurisdiction and allows you to verify safety resources if needed.

Common Mistakes

Using a non-HIPAA-compliant platform. After the end of the COVID-19 enforcement discretion period, using consumer-grade video platforms without a BAA is a HIPAA violation. Ensure your platform is designed for healthcare and that a BAA is in place.

Failing to address emergency protocols. This is the single most dangerous omission in telehealth consent documents. Without the client's physical address and local emergency resources, you cannot summon help if the client becomes acutely suicidal or experiences a medical emergency during a session.

Ignoring state licensure requirements. Providing telehealth services to a client who is physically located in a state where you are not licensed is practicing without a license, regardless of where you are located. This can result in disciplinary action, loss of licensure, and malpractice liability.

Not discussing the limitations of telehealth clinically. Some clients are not appropriate candidates for telehealth due to the severity of their symptoms, safety concerns, or the nature of their treatment. The consent process should include a clinical conversation — not just a signature — about whether telehealth is the right fit.

Assuming one consent covers all telehealth modalities. If you later add phone sessions, text-based therapy, or asynchronous messaging, your original video-session consent may not adequately cover the risks of those modalities. Update your consent when your service delivery model changes.